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Effect of Plant-Based Diet on Vascular Endothelial Function in Patients with Peripheral Arterial Disease
Debra Leslie, MPH, RDN1, Mary Levine, RD2, Garth Davis, MD3, Heather Hamza, CRNA4, John Rondash, RVT4, Peter H. Lin, MD5.
1Pasadena City College, Pasadena, CA, USA, 2California State University Channel Island, Camarillo, CA, USA, 3Houston Methodist Hospital, Houston, TX, USA, 4University Vascular Associates, Los Angeles, CA, USA, 5Baylor College of Medicine, Houston, TX, USA.

OBJECTIVES: Peripheral arterial disease (PAD) is characterized by impaired arterial circulation to the extremities caused in part to atherosclerosis, a condition which has been linked to a hypercholesteremic dietary lifestyle. This study examined the effect of the plant-based diet (PBD) on vascular function in PAD patients.
METHODS: A total of 24 patients with PAD and hypercholesterolemia were randomized to receive advice on PBD (n=12) or no specific dietary advice (control, n = 12). Biochemical parameters, including lipid profile, C-reactive protein, nitric oxide, and superoxide dismutase were measured at baseline and 4 months. Vascular function including brachial artery flow-mediated vasodilation (FMD), carotid intima-media thickness (IMT), carotid-femoral pulse wave velocity (PWV), and brachial-ankle PWV were measured at baseline and 4 months after dietary intervention.
RESULTS: Biochemical parameters were largely similar at baseline between the two groups. There was no change in any of the biochemical parameters in the control group at 4 months. However, patients in the PBD group had a significant decrease in total and LDL-cholesterol by 7.6% and 12.5%, respectively (P = 0.02). Nitric oxide levels were greater (17.68 13.42 μmol/L; P<0.01) in the PBD group at 4 months compared with baseline values (7.45 5.42 μmol/L), whereas there were no changes in the control group. At baseline, FMD was 4.36% 4.56% in the PBD group compared to 4.32 5.47% in the control group (P = 0.94). After four months, FMD was significantly improved in the PBD group compared to the control group (8.53 5.32% vs. 5.14 4.75%, P = 0.04). There were no differences in carotid-femoral PWV and brachial-ankle PWV in the control group at 4 months. In contrast, the PBD group showed a significantly lower carotid-femoral PWV (692.7 cm/sec versus 958.5 cm/sec; P = 0.04) and lower brachial-ankle PWV (1138.2 cm/sec versus 1525.7 cm/sec; P = 0.03) compared to the control group. The ankle-brachial index (ABI) was improved by 7.6% in the PBD group. No difference in carotid IMT was found between the two groups.
CONCLUSIONS: The present study shows that plant-based diet improves vascular endothelial function which may be due in part to nitric oxide production. Additionally, plant-based diet can result in decreased serum cholesterol which may further enhance vascular endothelial function.

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